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U4 Drug table > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What is the class for Acetazolamide (Diamox)

A

Carbonic anhydrase inhibitors

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2
Q

What is the mechanism for Acetazolamide (Diamox)

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

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3
Q

What are the therapeutics for Acetazolamide (Diamox)

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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4
Q

What are the important side effects for Acetazolamide (Diamox)

A

Increased K+ excretion and metabolic acidosis

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5
Q

What are the other side effects for Acetazolamide (Diamox)

A

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

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6
Q

What are the miscellaneous for Acetazolamide (Diamox)

A

Contraindicated in cirrhotic patients; FeNa = 5%

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7
Q

What is the class for Methazolamide (Neptazane)

A

Carbonic anhydrase inhibitors

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8
Q

What is the mechanism for Methazolamide (Neptazane)

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

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9
Q

What are the therapeutics for Methazolamide (Neptazane)

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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10
Q

What are the important side effects for Methazolamide (Neptazane)

A

Increased K+ excretion and metabolic acidosis

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11
Q

What are the other side effects for Methazolamide (Neptazane)

A

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

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12
Q

What are the miscellaneous for Methazolamide (Neptazane)

A

Contraindicated in cirrhotic patients; FeNa = 5%

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13
Q

What is the class for Dichlorphenamide (Daranide)

A

Carbonic anhydrase inhibitors

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14
Q

What is the mechanism for Dichlorphenamide (Daranide)

A

Inhibits luminal carbonic anhydrase at proximal tubule –> less activity of Na/H antiporter, decreased HCO3 and Na+ (and water) reabsorption

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15
Q

What are the therapeutics for Dichlorphenamide (Daranide)

A

Decrease intraocular volume/pressure and the prevention and treatment of mountain sickness

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16
Q

What are the important side effects for Dichlorphenamide (Daranide)

A

Increased K+ excretion and metabolic acidosis

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17
Q

What are the other side effects for Dichlorphenamide (Daranide)

A

Hepatic encephalopathy, BM depression, skin toxicity, allergic reactions

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18
Q

What are the miscellaneous for Dichlorphenamide (Daranide)

A

Contraindicated in cirrhotic patients; FeNa = 5%

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19
Q

What is the class for Aminophylline

A

Bronchodilator (Methylxanthine)

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20
Q

What is the mechanism for Aminophylline

A

Phosphodiesterase inhibition and enhanced signalling via increased cAMP and cGMP; works at proximal tubule; decreased HCO3 and Na+ (and water) reabsorption

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21
Q

What are the therapeutics for Aminophylline

A

Reduce inflammation and bronchospasm in moderate to severe asthma, night symptoms; NOT as diuretic

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22
Q

What are the important side effects for Aminophylline

A

Larger doses give nausea, vomiting, CNS stimulation or seizures, tachycardia/arrythmias

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23
Q

What are the miscellaneous for Aminophylline

A

FeNa = 5%; aminophylline = theophylline + ethyelenediamine (solubility agent); metabolized by liver; cimetidine and quinoline increase blood levels

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24
Q

What is the class for Mannitol (Osmitrol)

A

Osmotic diuretic

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25
Q

What is the mechanism for Mannitol (Osmitrol)

A

Opposes water and sodium reabsorption at proximal tubule –> increased osmolarity of tubular fluid

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26
Q

What are the therapeutics for Mannitol (Osmitrol)

A

Increased clearance of drugs, minimize renal failure (shock or surgery), decrease intraocular or intracranial pressures, diagnose oliguria

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27
Q

What are the important side effects for Mannitol (Osmitrol)

A

Risk of pulmonary edema

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28
Q

What are the miscellaneous for Mannitol (Osmitrol)

A

FeNa = 5%; must give IV; other osmotic diuretics include glucose, urea, isorbide

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29
Q

What is the class for Furosemide (Lasix)

A

Loop diuretic (- charge)

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30
Q

What is the mechanism for Furosemide (Lasix)

A

Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss

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31
Q

What are the therapeutics for Furosemide (Lasix)

A

Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis

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32
Q

What are the important side effects for Furosemide (Lasix)

A

Hypokalemia/hypocalcemia/hypomagnesemia (–> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside)

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33
Q

What are the other side effects for Furosemide (Lasix)

A

Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction

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34
Q

What are the miscellaneous for Furosemide (Lasix)

A

FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient; avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)

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35
Q

What is the class for Bumetanide (Bumex)

A

Loop diuretic (- charge)

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36
Q

What is the mechanism for Bumetanide (Bumex)

A

Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss

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37
Q

What are the therapeutics for Bumetanide (Bumex)

A

Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis

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38
Q

What are the important side effects for Bumetanide (Bumex)

A

Hypokalemia/hypocalcemia/hypomagnesemia (–> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside)

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39
Q

What are the other side effects for Bumetanide (Bumex)

A

Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction

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40
Q

What are the miscellaneous for Bumetanide (Bumex)

A

FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient; avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)

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41
Q

What is the class for Torsemide (Demadex)

A

Loop diuretic (- charge)

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42
Q

What is the mechanism for Torsemide (Demadex)

A

Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss

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43
Q

What are the therapeutics for Torsemide (Demadex)

A

Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis

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44
Q

What are the important side effects for Torsemide (Demadex)

A

Hypokalemia/hypocalcemia/hypomagnesemia (–> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside)

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45
Q

What are the other side effects for Torsemide (Demadex)

A

Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction

46
Q

What are the miscellaneous for Torsemide (Demadex)

A

FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient; avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)

47
Q

What is the class for Ethacrynic acid (Edecrin)

A

Loop diuretic (- charge)

48
Q

What is the mechanism for Ethacrynic acid (Edecrin)

A

Inhibits Cl portion of Na-K-2Cl cotransporter in luminal membrane at medullary and cortical (proximal) talH –> decreased K+, Ca++ and Na+ reabsorption, resultant K+ loss

49
Q

What are the therapeutics for Ethacrynic acid (Edecrin)

A

Crisis edema (pulmonary, CHF, cirrhosis), hypercalcemia, drug toxicity/OD; severe hypertension in setting of CHF or cirrhosis; sulfa-free

50
Q

What are the important side effects for Ethacrynic acid (Edecrin)

A

Hypokalemia/hypocalcemia/hypomagnesemia (–> arrhythmia), contraction alkalosis, increased BUN & creatinine, ototoxicity (esp. w/aminoglycoside)

51
Q

What are the other side effects for Ethacrynic acid (Edecrin)

A

Hyper -glycemia, -lipidemia, -uricemia; hypo -magnesia, -natremia; gout, photosensitivity, nephrocalcinosis, drug interactions; erectile dysfunction

52
Q

What are the miscellaneous for Ethacrynic acid (Edecrin)

A

FeNa = 25%; eventually causes increase in PT reabsorption,decreases positive & negative free water clearance; decreases cortex-medulla molarity gradient; avoid NSAIDs, take before salty meals, reduce salt intake; useful in patients with renal insufficiency (GFR < 30-40)

53
Q

What is the class for Chlorothiazide (Chlotride)

A

Thiazide diuretic (- charge)

54
Q

What is the mechanism for Chlorothiazide (Chlotride)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

55
Q

What are the therapeutics for Chlorothiazide (Chlotride)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

56
Q

What are the important side effects for Chlorothiazide (Chlotride)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

57
Q

What are the other side effects for Chlorothiazide (Chlotride)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

58
Q

What are the miscellaneous for Chlorothiazide (Chlotride)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

59
Q

What is the class for Hydrochlorothiazide (Microzide)

A

Thiazide diuretic (- charge)

60
Q

What is the mechanism for Hydrochlorothiazide (Microzide)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

61
Q

What are the therapeutics for Hydrochlorothiazide (Microzide)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

62
Q

What are the important side effects for Hydrochlorothiazide (Microzide)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

63
Q

What are the other side effects for Hydrochlorothiazide (Microzide)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

64
Q

What are the miscellaneous for Hydrochlorothiazide (Microzide)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

65
Q

What is the class for Chlorthalidone (Thalitone)

A

Thiazide-like diuretic

66
Q

What is the mechanism for Chlorthalidone (Thalitone)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

67
Q

What are the therapeutics for Chlorthalidone (Thalitone)

A

Reduce stroke risk, CHF events; HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

68
Q

What are the important side effects for Chlorthalidone (Thalitone)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

69
Q

What are the other side effects for Chlorthalidone (Thalitone)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

70
Q

What are the miscellaneous for Chlorthalidone (Thalitone)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

71
Q

What is the class for Quinethazone (Hydromox)

A

Thiazide-like diuretic

72
Q

What is the mechanism for Quinethazone (Hydromox)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

73
Q

What are the therapeutics for Quinethazone (Hydromox)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

74
Q

What are the important side effects for Quinethazone (Hydromox)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

75
Q

What are the other side effects for Quinethazone (Hydromox)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

76
Q

What are the miscellaneous for Quinethazone (Hydromox)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

77
Q

What is the class for Metolazone (Zaroxolyn)

A

Thiazide-like diuretic

78
Q

What is the mechanism for Metolazone (Zaroxolyn)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

79
Q

What are the therapeutics for Metolazone (Zaroxolyn)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

80
Q

What are the important side effects for Metolazone (Zaroxolyn)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

81
Q

What are the other side effects for Metolazone (Zaroxolyn)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

82
Q

What are the miscellaneous for Metolazone (Zaroxolyn)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

83
Q

What is the class for Indapamide (Lozol)

A

Thiazide-like diuretic

84
Q

What is the mechanism for Indapamide (Lozol)

A

Inhibits the Cl portion of the Na-Cl cotransporter in the luminal membrane at the early distal tubule –> decreased Na+ (and water) reabsorption, increased Ca++ reabsorption, resultant K+ loss

85
Q

What are the therapeutics for Indapamide (Lozol)

A

HTN (intravascular contraction), chronic edema (cardiac insufficiency), idiopathic hypercalciuria (stones), nephrogenic diabetes insipidus

86
Q

What are the important side effects for Indapamide (Lozol)

A

Hypokalemia/hypercalcemia, contraction alkalosis, increased BUN & creatinine

87
Q

What are the other side effects for Indapamide (Lozol)

A

Hyper -glycemia, -lipidemia, -uricemia, -calcemia; hypo -magnesia, -natremia; gout, photosensitivity, impotence, drug interactions

88
Q

What are the miscellaneous for Indapamide (Lozol)

A

FeNa = 8%; lethal interaction w/quinidine (v. tach –> fib, may be due to hyperkalemia); avoid NSAIDs, bile sequestrants; increased risk of hypokalemia w/anti-inflammatory steroids or Amphotericin B; decreases positive free water clearance

89
Q

What is the class for Amiloride (Midamor)

A

K+-sparing diuretic; renal ENaC inhibitor (+ charge)

90
Q

What is the mechanism for Amiloride (Midamor)

A

Blocks Na channel and Na/H antiporter in lumenal membrane at the late distal tubule and collecting duct –> decreased K+ secretion and distal tubule acid secretion, increased Ca++ absorption

91
Q

What are the therapeutics for Amiloride (Midamor)

A

Combination with other diuretics to prevent hypokalemia; edema, idiopathic hypercalciuria (stones); lithium-induced polyuria & toxicity, Liddle syndrome, mucocilliary clearance

92
Q

What are the important side effects for Amiloride (Midamor)

A

Hyperkalemia in patients with renal failure or on ACE inhibitors

93
Q

What are the miscellaneous for Amiloride (Midamor)

A

Contraindicated in patients with renal failure (hyperkalemia), ACEi/ARB use; FeNa = 2%

94
Q

What is the class for Triamterene (Dyrenium)

A

K+-sparing diuretic; renal ENaC inhibitor (+ charge)

95
Q

What is the mechanism for Triamterene (Dyrenium)

A

Blocks Na channel and Na/H antiporter in lumenal membrane at the late distal tubule and collecting duct –> decreased K+ secretion and distal tubule acid secretion, increased Ca++ absorption

96
Q

What are the therapeutics for Triamterene (Dyrenium)

A

Combination with other diuretics to prevent hypokalemia; edema

97
Q

What are the important side effects for Triamterene (Dyrenium)

A

Hyperkalemia in patients with renal failure or on ACE inhibitors

98
Q

What are the other side effects for Triamterene (Dyrenium)

A

Megaloblastic anemia in patients with liver cirrhosis

99
Q

What are the miscellaneous for Triamterene (Dyrenium)

A

Contraindicated in patients with renal failure (hyperkalemia); FeNa = 2%

100
Q

What is the class for Spironolactone (Aldactone)

A

K+-sparing diuretic; aldosterone receptor antagonist

101
Q

What is the mechanism for Spironolactone (Aldactone)

A

Competes for aldosterone receptor, inhibiting mRNA transcription and translation –> decreased Na and K channels, decreased number and activity of Na-K-ATPase pumps in the late distal tubule and collecting duct –> decreased K+ secretion, distal tubule acid secretion

102
Q

What are the therapeutics for Spironolactone (Aldactone)

A

Reduction in CHF mortality (30% in NYHA class III and IV); combination with other diuretics to prevent hypokalemia; edema; primary and secondary aldosteronism; hypertension; anti-testosterone agent

103
Q

What are the important side effects for Spironolactone (Aldactone)

A

Hyperkalemia in patients with renal failure or on ACE inhibitors; male patients may have gynecomastia, erectile dysfunction, and loss of libido; female patients may have amenorrhea, breast soreness, and oligomenorrhea

104
Q

What are the miscellaneous for Spironolactone (Aldactone)

A

Contraindicated in patients with renal failure (hyperkalemia); FeNa = 2%; requires a salt-restricted diet; only drug not requiring tubular lumen access

105
Q

What is the class for Conivaptan (Vaprisol)

106
Q

What is the mechanism for Conivaptan (Vaprisol)

A

Vasopressin (ADH) receptor antagonist working at collecting duct –> increased free water excretion

107
Q

What are the therapeutics for Conivaptan (Vaprisol)

A

Hyponatremia (SIADH, CHF)

108
Q

What are the miscellaneous for Conivaptan (Vaprisol)

A

New drug class with unproven clinical benefit

109
Q

What is the class for Tolvaptan (Samsca)

110
Q

What is the mechanism for Tolvaptan (Samsca)

A

Vasopressin (ADH) receptor antagonist working at collecting duct –> increased free water excretion

111
Q

What are the therapeutics for Tolvaptan (Samsca)

A

Hyponatremia (SIADH, CHF)

112
Q

What are the miscellaneous for Tolvaptan (Samsca)

A

New drug class with unproven clinical benefit

U4 Drug table (7 decks)

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